Abstract 13048: Impact of Atrial Fibrillation on the Clinical Course of Apical Hypertrophic Cardiomyopathy
Introduction: Apical hypertrophic cardiomyopathy (A-HCM) has been considered a “benign” form of HCM, with limited data on long-term outcome. However, the clinical impact of atrial fibrillation (AF) in A-HCM is largely unresolved.
Hypothesis: We analyzed whether AF has a prognostic implication of in an A-HCM cohort.
Methods: Occurrence of AF and outcome were assessed in 346 consecutive A-HCM patients (age at diagnosis, 62 ± 11 years; 67.6% male) who were followed up for 6.3 ± 3.4 years. We compared mortality and stroke between A-CMP patients with and without AF.
Results: AF occurred in 103 A-HCM patients (30%; incidence, 3%/y) and was independently predicted by advanced age and increased left atrial size (anteroposterior diameter < 45 mm) at diagnosis. Patients with AF had higher incidence of all cause death (11.7% vs. 2.1%, p < 0.001), cardiovascular death (7.8% vs. 0.8%, p = 0.001) and stroke (20.4% vs. 2.5%, p < 0.001) than those without AF. When adjusted with age and gender, patients with AF still had increased risk for cardiovascular death (Odds ratio(OR) 8.4; 95% confidence interval (CI) 1.69-41.5, p = 0.009) and stroke (OR 8.7; 95% CI 3.31-22.6, P < 0.001). In patients with stroke (n=18), 16 (89%) patients had AF. AF was detected at the time of stroke in 11 (61%) patients and within 30 days in 4 (25%) patients. AF was observed 1.5 years after stroke in a patient. The cause of death was stroke in 5 (63%) out of 8 AF patients.
Conclusions: In patients with A-HCM, AF was common with annual incidence of 3% and was associated with substantial risk for stroke and mortality. Especially, AF was observed in most A-HCM patients with stroke. This finding suggests that AF should be carefully managed in A-HCM.
Author Disclosures: S. Lee: None. J. Park: None. J. Uhm: None. J. Kim: None. H. Pak: None. M. Lee: None. B. Joung: None.
- © 2014 by American Heart Association, Inc.